Mobility - Assistive devices for ambulation: Nursing skills

Assistive devices are tools to promote patient movement including ambulation devices and mechanical lifts that move a patient from one location to another.

Before using an assisted device, the registered nurse or physical therapist will assess the patient determine which device is best for the patient and provide them with initial teaching on the selected device.

However, as the licensed practice nurse or LPN, also known as a licensed vocational nurse or LVN, you should know when these devices are appropriate and determine if they're being correctly used by the patient while reinforcing any previous teaching.

Common ambulation devices include walkers, canes and crutches. Let's start by looking at walkers.

These are lightweight devices that consist of a metal frame, two hand grips and four legs. They provide stability due to their wide base.

So they're used for patients who can bear weight on their feet but have trouble walking due to weakness or balance issues before using a walker, make sure the hand grips are positioned at your patient's waist level and that the ends of the legs have non slip covers to use a walker, assist your patient to stand straight while holding the hand grips if the walker doesn't have wheels, they'll move it forward by lifting their walker and moving it 6 to 10 inches in front of them and then setting it down on the ground, then using the walker for support, they'll move one leg forward, followed by the other.

If the walker has two wheels on the front legs, your patient can push it to move forward. There are also walkers with four wheels called rollator walkers.

These walkers tend to roll forward. So brakes are built into the device.

Next up, canes are lightweight devices typically made of wood or metal that consist of a handle, a shaft and legs. There are single leg, triple leg or quad leg, canes, canes with multiple legs typically provide more stability but can be heavy or inconvenient to transport.

Canes are used by patients who can bear weight but have weakness in one of their legs. For example, a patient who has left leg weakness from a stroke, the cane's handle should be at your patient's hip level and the ends should have non slip covers.

Your patient should hold the cane on their stronger side or the side without weakness. The cane end should rest flat on the ground and then be lifted and moved forward 6 to 10 inches before being placed flatly on the ground.

Again, your patient should then step forward with their weaker leg first using the cane for support. After balance is established, they should move the stronger leg forward to meet the weaker leg.

Now, there are two common types of crutches, underarm, or axillary crutches and forearm crutches also called Canadian or lofstrand crutches.

Axillary crutches are often used temporarily. Like when someone is recovering from a leg fracture, they extend from the axilla or armpit to the ground.

So to prevent compression of the axillary nerves, they should be adjusted to leave 2 to 3 finger widths between the top of the crutch and the axilla.

Your patient should be able to reach the handle of the crutches with their elbows, slightly flexed. Forearm, crutches are used by people who have permanent or chronic leg weakness or pain.

They have a hand grip and a cuff that attaches to the patient's arm which allows the crutch to stay attached when the person needs to use their hands.

For other tasks with your patient's arms relaxed and slightly flexed. The hand grip should be at the level of their hand and the cuff should be positioned at 1 to 2 inches below the bend of the elbow prior to using any type of crutch.

Be sure to confirm all pieces are secured tightly and that the non slip tip at the end of each leg is intact. Now, when preparing to assist your patient with ambulation, be sure to check the health care provider's orders to make sure the patient is safe to ambulate during ambulation, you'll perform ongoing assessments for any signs of distress that might require intervention such as shortness of breath, reports of pain or dizziness or the appearance of instability.

Remember to document your patient's ambulatory efforts and any complications if the equipment used during ambulation seems to be the wrong size or type based on their needs.

Contact the registered nurse. Ok.

Let's switch gears and talk about mechanical lifts. These can be used to safely move patients who are immobile, can't bear any weight on their legs or have poor upper body strength.

Some common types of mechanical lifts include sealing mounted lifts, hydraulic floor lifts or power driven lifts. Each of these devices is similar but may have slightly different instructions based on the manufacturer's specifications.

So be sure you're familiar with the lift you're using before transferring your patient when using a mechanical lift, start by collecting your supplies, including the lift device, the patient sling and at least one additional staff as you position the lift, make sure there's enough room to access the lift controls and to attend to your patient as needed.

Then with the other staff member, roll the sling under your patient and secure it to the lift device. Next, operate the lift, making sure your patient remains safe before during and after the procedure.

Once they're safely transferred, you'll unhook and remove the sling from under them. All right.

As a quick recap, assistive devices are tools that promote patient movement and include ambulation devices and mechanical lifts.

The registered nurse or physical therapist will assess the patient and determine which device should be used for each patient and provide them with initial teaching on the selected device.

As the LPN or LVN, you can reinforce teaching, use the device to promote mobility and complete ongoing assessment of your patient's mobility and use of assisted devices.